"Plug and Play" Hospitals

"Plug and Play" Hospitals

Breathe in, breathe out: A ventilator and camera connected to a computer demonstrate how “plug and play” medical devices could help prevent medical errors. Traditionally, a doctor who wants to take an x-ray of a patient on a ventilator has to manually stop the device so that the lungs’ motion won’t blur the image. But that introduces the risk of accidentally leaving the ventilator off for too long. This experimental setup at Massachusetts General Hospital times photographs taken by a webcam so that they correspond to the full-exhalation or full-inhalation states of the ventilator.

The bewildering variety of new medical devices
in U.S.
hospitals promises higher standards of care. But it also poses new
opportunities for error. A growing number of physicians believe that the
interoperability of medical devices–their ability to communicate with each
other–could make hospitals safer and more efficient.

“Today, there are many
proprietary systems available from different vendors, but the problem is, these
systems can’t talk to one another,” says Douglas Rosendale,
a surgeon who works on information integration at Veterans Health Administration
and Harvard Brigham and Women’s Hospital. “If they can’t interface, then they
can’t share information, which could have an impact on patient care.” Estimates
of the number of preventable deaths caused each year by medical errors in
American hospitals range from 98,000 to 195,000.

Julian Goldman, director of the Center for Integration of Medicine and Innovative
Technology’s Medical Device Interoperability Program, based at Massachusetts General Hospital, has developed two
demonstration projects that illustrate the idea of the “plug and play”
operating room. The first project is an integrated ventilator. A common problem
in hospitals is taking chest x-rays of patients on ventilators, says Goldman. To
keep the lungs’ movements from blurring the image, doctors must manually turn
off the ventilator for a few seconds to take the x-ray. But then they run the
risk of inadvertently leaving the ventilator off for too long, says Goldman.

To simulate an x-ray machine, Goldman
used a webcam, which he connected to a ventilator and a computer. He synched the
camera with the ventilator so that it would capture images only when the
ventilator was at the point of full inhalation or exhalation. Goldman says that
as a result of his demonstration, standards for ventilators are in the process
of being revised so that future versions of the devices will include a pause
function and will be subject to network control, moving toward
interoperability.

“That’s an example where you
actually avoid the risk by simply not having to turn off the ventilator at
all,” says Peter Szolovits, a professor of computer science at MIT who studies
medical data integration. “In other cases where you have a bunch of data
simultaneously, you can do a better job of trying to understand what’s going on
with the patient,” he says.

Device interoperability could also
reduce the large number of false alarms that nurses must contend with. “If you
go into an ICU, it’s a madhouse,” says Szolovits. “There are alarms going off
constantly, because each alarm is separate from the others, so none of them
have an integrated view of what’s going on with the patient.” If the data from
medical monitors were integrated, he says, alarms would be more likely to indicate
something truly important.